When the war between the Liberation Tigers of Tamil Eelam (LTTE) and the Sri Lankan government ended on May 16, Doctors Without Borders/Médecins Sans Frontières (MSF) emergency coordinator Lauren Cooney and her team provided emergency medical care at the Omanthai checkpoint. Here, tens of thousands of civilians were pouring out of the conflict zone and into Vavuniya district to the south. The MSF team identified the most seriously injured people in need of immediate care and treated many of them on the spot. Others they sent to Vavuniya hospital where MSF has been working with Ministry of Health staff to treat people with severe injuries.

Here, Cooney describes the situation:

"We were working at the site where people were first arriving into the Vavuniya area, so we were working sixteen hours a day, seeing about 150 to 200 patients during that time. And that wasn’t all of them, but that was the ones that we triaged out, as being the ones that we could get done.

It was very distressing, really, to see people with these wounds, to see people coming out that have been really living in a terrible situation, having experienced terrible events. Just to see the look on the faces of all of these people arriving and scared, not knowing what’s going to happen to them now. Seeing really terrible wounds, very big wounds, fractures—one girl who’d had the bottom part of her leg blown off—a 16-year-old girl—after stepping on a land mine. It’s really quite indescribable actually: the situation’s been quite overwhelming and for all of us—in fact many of us are very experienced in emergencies and it’s really, for us, some of the worst things that we’ve seen really, to see this big movement of people and to see the level of distress that they feel.

For the teams working in the hospital: really they were working around the clock: the Ministry of Health teams and the MSF teams were working all hours to try to get through the caseload of the most urgent cases. That’s not to mention all the other ones that are still waiting because it was not immediately life-saving but they still need, so in the hospital that’s still going on, the teams are really working very long hours.

There’re multiple priorities at once and I think that the immediate priority is to deal with the emergency needs at all levels. So at the hospital level the hospitals need to be able to cope with this huge increase in the population in the area so that’s being helped of course by having additional hospitals such as the MSF field hospital, but it still means that the Ministry of Health hospitals—like the Vavuniya hospital—have to cope with a much-increased population number so that’s a real priority to be able to provide the level of secondary health care services that’s needed for this big population who have a lot of wounds especially—which need hospital-level care. And at the camp level for the primary health care services there’s a real need to have emergency-level primary health care services so there are Ministry of Health camps in the clinics and lots of doctors and nurses are working but there’s really a need to increase those services as rapidly as possible.

There is a very good plan that exists, to have health posts and to have referral centres and some of that plan is already in place but there has to be emergency services to deal with the immediate needs as well. And that includes basic health care, medical services as well as basic wound care services as well.

At the very base of everything is to ensure the level of water and sanitation and the hygiene within the camps is good, because it’s an overcrowded situation—you have many people living together—so the risks for communicable diseases are very high so that’s a real priority as well.

But, importantly, there’s an immediate need for mental health care services as well. This is a large, traumatized population and there’s a need to be able to deal, not just with the individual cases who perhaps need a high level of psychiatric care or counseling care, but also to be able to deal with people on a group basis—on a psycho-education level—to just to be able to discuss to people what’s happened to them."